Adding Assisted Living Services To Subsidized Housing

#2002-01 January 2002

Adding Assisted Living Services To Subsidized Housing:

Serving Frail Older Persons With Low Incomes

by Robert Wilden

and Donald L. Redfoot

The AARP Public Policy Institute, formed in 1985, is part of the Policy and Strategy Group at AARP. One of the missions of the Institute is to foster research and analysis on public policy issues of importance to mid-life and older Americans. This publication represents part of that effort. The views expressed herein are for information, debate, and discussion, and do not necessarily represent official policies of AARP.

2002, AARP. Reprinting with permission only. AARP, 601 E Street, N.W., Washington, DC 20049

ACKNOWLEDGMENTS

The authors thank the contact persons listed in Appendix B, without whose cooperation and timely assistance, this study would not have been possible. These individuals invested a significant amount of time filling out the Project Interview Schedule, meeting with the lead author, and reviewing draft material.

Andrew Kochera of the AARP Public Policy Institute (PPI) staff provided important technical assistance, including estimates of the number of older persons living in federally subsidized housing and of the disability levels of older renters in subsidized housing. Patricia Forsythe did extensive copy editing that greatly improved the organization and readability of the report. Sheel M. Pandya of the PPI staff provided valuable assistance in the final "cleaning up" of the report.

Finally, the authors also thank the anonymous reviewers for their comments and recommendations, which have immensely improved the final version of this report.

TABLE OF CONTENTS

Foreword....................................................................................... i

Executive Summary........................................................................... ii

I. Introduction................................................................................. 1

II. Purposes.................................................................................... 2

III. Methodology.............................................................................. 2

IV. The Potential Demand for Assisted Living Services in Subsidized Housing: A Research Review .......................................................... 6

A. Federally Subsidized Housing for Older Persons.................. 6 B. Targeting to Those in Need.......................................... 7 C. Capacity to Deliver Services.......................................... 11 D. Conclusions from the Research Review............................ 13 E. References for Research Review ................................... 14

V. Adding Assisted Living Services to Subsidized Housing: Findings from Case Studies............................................................. 17

A. Financial Issues.....................................................17 B. Service Delivery Issues............................................23 C. Level of Effort and Type of Housing............................26 D. Management Issues................................................28 E. Other Issues.........................................................30 F. Conclusions from Case Studies.................................. 31

VI. Case Studies in Providing Assisted Living in Subsidized Housing............... 33

Connecticut........................................................................... 33 Immanuel House............................................................ 33 Tower One and Tower East................................................ 34

Kentucky.............................................................................. 37 Christian Church Homes of Kentucky....................................37

Maryland.............................................................................. 39 Springvale Terrace Home, Inc............................................. 39 Cedar Lane Apartments.................................................... 41 Homecrest House............................................................ 43

Minnesota............................................................................. 46 Minneapolis Public Housing Authority.................................. 46 St. Paul Public Housing Authority........................................47

New Hampshire...................................................................... 48 Stafford House............................................................... 48

New Jersey............................................................................ 51 Asbury Tower............................................................... 51 Bernard Dubin House...................................................... 53 VNA Central Jersey Personal Care, Inc................................. 54

North Carolina........................................................................ 55 Koinonia Apartments....................................................... 55 Preiss-Steele Place.......................................................... 56 Astor Dowdy Project....................................................... 58

Virginia................................................................................ 60 Culpepper Garden........................................................... 60

Washington........................................................................... 62 The Housing Authority of Vancouver.................................... 62

Appendix A ? Project Interview Schedule.................................................64 Appendix B ? Contact Persons ............................................................. 71 Appendix C ? Glossary...................................................................... 74

List of Tables Table 1................................................................................. 4 Table 2................................................................................. 6 Table 3................................................................................. 8 Table 4................................................................................. 9 Table 5................................................................................. 10 Table 6................................................................................. 10 Table 7................................................................................. 18 Table 8................................................................................. 21

FOREWORD

This report coincides with a sea change in policy discussions regarding federal housing programs for older persons. Once the bastion of a "bricks and mortar" approach that narrowly defined the role of housing programs as providing a place to live, the Department of Housing and Urban Development (HUD) has begun to chart a new focus of providing supportive services to enable frail older residents to "age in place" longer. As a recent HUD report noted (HUD, 1999):

Public, private, and nonprofit owners of HUD-assisted elderly housing have worked hard to bring supportive services into their conventional multifamily housing models through the use of service coordinators, for example. Nonetheless, there is mounting evidence that many of their increasingly frail residents have more comprehensive assistance needs which demand supportive environments such as assisted living. Without extending such options to lower income seniors, the number of households forced prematurely into institutional living will certainly increase.

Congress has also focused on adding the supportive services that are typically available in assisted living facilities to traditional subsidized housing projects for older persons. The past two HUD appropriations from Congress (FY 2000 and 2001) have included funds to retrofit subsidized elderly housing projects for use as assisted living. In addition, Congress has authorized and funded a "Commission on Affordable Housing and Health Care Facility Needs in the 21st Century." The Commission is charged with conducting a study that:

Identifies and analyzes methods of promoting a more comprehensive approach to dealing with housing and supportive service issues involved in aging and the multiple governmental agencies involved in such issues....

To explore some promising new models of service delivery, Robert Wilden, past national director of elderly housing at the HUD, and I have examined the current state of assisted living services in federally subsidized housing. The report that follows is but a first step in identifying residents' needs and examining issues that arise when assisted living services are added to subsidized housing for older persons. Further research is especially needed on the long-term quality outcomes of such services and programs.

This report can be useful to policy decisionmakers, practitioners, housing providers, and consumer advocates as they search for ways to promote the independence and dignity of frail older persons with modest means. We believe the report will be especially timely in light of the work of the National Commission and recent Congressional efforts to make federal housing programs a major setting for such efforts in the future.

Donald L. Redfoot Senior Policy Advisor Public Policy Institute, AARP

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